关节成形术围术期影响输血量的相关因素分析

Analysis of relative factors on transfusion during perioperative total hip arthroplasty

目的：探讨在初次单侧人工全髋关节置换术（ THA）围手术期中，影响患者输血量的相关因素，为临床合理输血提供参考依据。方法：收集2009年12月1日～2013年12月31日在我院实施初次单侧人工全髋关节置换手术的130例患者病历资料进行回顾性分析，根据患者输异体血的多少分为≤2单位（ U）组和＞2U组，记录患者的年龄、性别、体重、病因、术前凝血酶原时间（PT）、术前活化部分凝血酶原时间（APTT）、术前纤维蛋白原（Fib）浓度、术前血小板（Plt）计数、术前血红蛋白（Hb）浓度、术前红细胞比积（Hct）、麻醉方式、手术入路、美国麻醉医师协会（ASA）分级、植入物类型、术后是否应用抗凝药物、术中出血量、手术时间、术后引流量、隐性失血、是否合并有基础疾病、手术组等指标，并进行统计学分析。结果：术中输血量≤2 U共有患者109例，＞2U有21例；术后输血量≤2U共有患者92例，＞2U有38例。2组中麻醉方式、术中出血量、手术时间在术中差异有统计学意义（P＜0．05）；术前血红蛋白浓度、术前红细胞比积、术后引流量、隐性失血量在术后差异有统计学意义（P＜0．05）；而年龄、BMI可能是通过多方面共同作用来影响围术期输血。结论：影响术中输血量的因素有麻醉方式、术中出血量、手术时间，而影响术后输血量的因素有术前血红蛋白浓度、术前红细胞比积、术后引流量、隐性失血量。

Objective：To discuss the relevant factors which affect unilateral total hip arthroplasty surgery perioperative blood transfusion volume and provide references for clinical reasonable transfusion.Methods： The patients who underwent unilateral total hip arthroplasty surgery in Peking University Shenzhen hospital from 2009.12.1 to 2013.12.31 were divided into less than or equal 2U group and more than 2U group according to blood transfusion volume.Record patients＇age, sex, weight, etiology, preoperative prothrombin time （ PT） , preoperative activated partial thromboplastin time （APTT）, preoperative fibrinogen （Fib） concentration, preoperative platelets （Plt） count, preoperative hemoglobin （ Hb） concentration, preoperative hematocrit （ Hct） , anesthesia, surgical approach, the American Socie-ty of Anesthesiologists （ ASA） classification, type of implant, whether to apply anti-coagulation medication after operation, intraoperative blood loss, surgery time, postoperative drainage, hidden blood loss, whether or not associated with underlying diseases, surgery group and other indicators, and then retrospectively analyzed.Results：There were 109 patients＇transfusion volume were less than or equal 2U and 21 cases more than 2U in intraoperative;92 patients＇transfusion volume less than or equal 2U and 38 cases more than 2U after operation. The differences in anesthesia, blood loss, operative time were statistically significant （P〈0.05） between two groups in intraoperative;preoperative hemoglobin concentration, preoperative hematocrit, postoperative drainage, hidden blood loss was significantly （P〈0.05） after surgery;while age and BMI possibly are the result which various affects together.Conclusion： Anesthesia, blood loss, operative time should be the factors which affect intraoperative transfusion volume in total hip arthroplasty;and preoperative hemoglobin concentra-tion, preoperative hematocrit, postoperative drainage, hidden blood loss affect postoperative transfusion volume in total hip arthroplasty.